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Colleges & Universities Students & Participants Liability Programs
Rockhurst University Student Health Insurance Plan
Claims

If you obtain treatment from a PHCS or MultiPlan provider, the provider will file a claim for you. If not, please send your bills to the address listed below. This address is also listed on the back of your health insurance ID card.

Claim Form

Paper Claim Form• download now
Online Claim Form• Online

Other Insurance Information Form

Paper Form• download now
Online Form• Online

Pre-Existing Condition Form

Paper Form• download now
Online Form• Online

Accident Form

Online Form• Online

Authorization Forms

Authorization to Release Information
(111K PDF)*
• download now


Mail completed forms to:
Summit America Insurance Services
P.O. Box 25936
Overland Park, KS 66225


Submit a Claims question

* PDFs require Adobe Reader v.6.0 or later